An in-depth guide from the team at Paradise Medical Center Dermatology Clinic in Miami, FL.
Call (786) 738-9515Moderate to severe acne is more than a cosmetic problem — it's an inflammatory medical condition that can leave permanent scars and damage self-esteem if undertreated. The good news: modern dermatology can clear nearly any case of acne with the right combination of medication and procedures.
Here's how we approach moderate to severe acne at our Miami clinic — from initial assessment through long-term maintenance.
Moderate: Multiple inflamed papules and pustules across face, sometimes chest/back. Some scarring or pigmentation beginning.
Severe: Deep nodules and cysts, widespread inflammation, significant scarring risk, often resistant to over-the-counter treatments.
When you've tried drugstore products for 2–3 months without results, you've outgrown what they can offer. Prescription treatment becomes the next step. See our cystic acne page for severe cases.
Your first visit includes a full skin examination, review of your acne history, current and past treatments, hormonal symptoms (irregular cycles, excess hair growth — clues to hormonal acne), medications, diet patterns, and stress factors.
For women with hormonal patterns, we may order labs (testosterone, DHEA-S, free testosterone) to identify underlying causes. This holistic assessment lets us treat the cause, not just the symptom.
Most moderate cases respond well to medical-strength topicals:
Topical retinoids (tretinoin, adapalene, tazarotene): Normalize skin cell turnover, prevent clogged pores. The single most important long-term acne medication.
Topical antibiotics (clindamycin) combined with benzoyl peroxide: Reduce bacteria and inflammation while preventing antibiotic resistance.
Azelaic acid: Anti-inflammatory and brightening for post-acne marks.
Dapsone gel: Excellent for adult female inflammatory acne.
For more inflammatory or treatment-resistant acne:
Oral antibiotics (doxycycline, minocycline): Used short-term (3–4 months) to control inflammation while topicals take effect.
Spironolactone: Highly effective for adult female hormonal acne (jawline, chin breakouts). Blocks androgen effect on oil glands.
Combined oral contraceptives: FDA-approved for acne in appropriate candidates.
Isotretinoin (Accutane): Reserved for severe, scarring, or treatment-resistant acne. The most effective acne treatment ever developed — typically produces long-term remission. Requires monthly monitoring through the iPLEDGE program. Read the FDA isotretinoin guidance.
Cortisone injections: Single deep cysts can be flattened in 24–48 hours.
Chemical peels (salicylic): Reduce active breakouts and fade post-acne marks.
LED therapy: Blue light reduces acne bacteria; red light reduces inflammation.
Extractions: Safe medical extraction of comedones to prevent rupture and scarring.
Once active acne is controlled, we address the marks left behind:
Post-inflammatory hyperpigmentation: Topical lighteners, chemical peels.
Atrophic (depressed) scars: Microneedling with PRP, subcision, dermal fillers. Read our acne scar guide.
After clearing, most patients continue a maintenance topical (usually retinoid + benzoyl peroxide) indefinitely to prevent recurrence. Acne is a chronic condition — maintenance therapy is part of long-term success.
Ready to learn more? Visit our dedicated service page or call (786) 738-9515 to schedule a consultation.
Topicals — 6–8 weeks. Oral antibiotics — 4–6 weeks. Isotretinoin — significant clearing by month 3–4.
Most patients avoid permanent scarring with prompt treatment. Existing scars can be improved with procedures.
Yes when properly monitored. The iPLEDGE program ensures monthly bloodwork and pregnancy prevention for female patients.
Often — especially for hormonal evaluation and isotretinoin monitoring.
High glycemic foods and skim dairy may worsen acne in some patients. We provide individualized dietary guidance.
Speak with our medical team about a personalized plan.
Call (786) 738-9515